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Please provide information regarding any insurance policies and information regarding claims filed and paid, if any, in the designated <br /> spaces below. If no claim was filed under an insurance policy listed below,fill in the applicable blank with"None." <br /> Insurance Company Name NONE <br /> Policy Number NONE <br /> Type of Insurance NONE <br /> Claim Number NONE <br /> Settled Amount NONE <br /> Insurance Company Name NONE <br /> Policy Number NONE <br /> Type of Insurance NONE <br /> Claim Number NONE <br /> Settled Amount NONE <br /> Insurance Company Name NONE <br /> Policy Number NONE <br /> Type of Insurance NONE <br /> Claim Number NONE <br /> Settled Amount NONE <br /> Insurance Company Name NONE <br /> Policy Number NONE <br /> Type of Insurance NONE <br /> Claim Number NONE <br /> Settled Amount NONE <br /> ` E VE R E T T tvasrtIvcroN Everett CARES Small Business Grant Program Round 3 page 9 <br />